Insurance policy, processes
and more at Naruvi Hospitals

Patient needs to visit the TPA Help Desk on the ground floor to submit a copy of his/her Insurance TPA ID card and patient Identity proof, proposer KYC documents, all investigations reports and the consultation paper which is relevant to present hospitalization. Pre-authorisation form has to be filled which has two parts. Part 1 needs to be filled by the patient or the patient’s family and part 2 needs to be filled by the Hospital authority/Treating doctor. The completely filled form should be mailed to Respective TPA/Insurance. Once the preauthorisation form is received by TPA/Insurance, the case will be processed within 4 hours and the initial authorization letter (approved or rejected) will be emailed back to the hospital by their respective TPA/Insurance.

On the date of discharge, the hospital team will have to send the final bill the break up and discharge summary to Respective TPA/Insurance. After the receipt, within 4 hours, the enhancement (as per policy terms and conditions) will be processed, after deducting the non medical expenses (paid by the patient). Post this approval letter will be sent to hospital by email.

Once the shortfall is raised, Hospital will respond within 8 hours based on the query.

Non Medical expenses are: Admission fees, Registration fees, gloves, blade, water bed, food & beverages, extra bed etc.

Refer IRDA Non payable list as per Policy terms and conditions

Minimum 24 hours of hospitalization (if not day-care) with an active line of treatment is required for cashless treatment.

However, there are a few specific ailments specified in the policy which can be covered even though the period of hospitalization is less than 24 hours Such as Dialysis, Chemotherapy, Radiotherapy, Eye Surgery etc.

Rejection will be done as per the policy terms and coverage, These are a few reasons for rejection:

1. If hospitalization is for observation & investigation purpose
2. If any particular ailment/disease/treatment is found not covered under policy term and condition
3. If found that the treatment can be done under OPD basis
4. If found that no active line of treatment is available
5. If Shortfall and the policyholder has not responded within the given TAT
6. If policy is invalid
7. Rejection of cashless is not a denial of treatment

In such a situation the policyholder will be liable to pay the difference amount. We will inform the patient about the policyholder’s eligible amount and the hospital will recover the amount over and above the credit amount from the policyholder directly.

What are the different types of Claims?

Cashless claim

Reimbursement claim

Policy holder has to intimate Respective TPA/Insurance before sending the claim documents if he/she wants to claim after discharge. Intimation has to be given within the TAT as per the insurance company.

Policyholder will need to download the claim form from Respective TPA/Insurance . The claim form contains 4 pages which includes a medical certificate also. The medical certificate needs to be filled in by the Treating doctor with the hospital seal and doctor’s signature. The policyholder should fill the claim form and should attach all his original bills and courier it to the Respective TPA/Insurance (respective branches).

Respective TPA/Insurance. will assess the validity of the claim based on the documents submitted, validate the policy, validate the treatment undergone and settle the claim within the claim settlement parameters. If the claim is not adhering the parameters, the case would be rejected.

Yes, you will be intimated on your claim status on your updated email id from our Insurer database.

Visit TPA help desk or call customer care Toll-free for status of the claim

1. Preauth form duly signed
2. TPA/Insurance ID card
3. Identity Proof (photo copy)
4. Proposer KYC documents (AADHAR & PAN Card)
5. last 4 years Policy Copy (applicable for retail policyholders)
6. First consultation paper
7. MLC /FIR copy for all RTA cases.
8. Investigation reports like MRI, ECG, CT scan, and X-Ray etc – relevant to present admission
9. Non Influence of Alcohol report from first treating doctor

Shortfall documents are those which are not submitted by the claimant/Hospital, and are mandatory for further claim process.

The amount which is not approved is disallowed amount such as Non medical expenses, aliment capping, exceeds Sum insured / aliment limit Etc

Day-Care surgeries are those which do not require 24 hours of hospitalization such as Cataract (Eye) surgery, Dialysis, Kidney stone removal, Chemotherapy, D&C etc.

Depending on Insurance policy some of the Day-Care surgeries are payable according to terms and conditions.

For queries: kindly visit TPA Help Desk situated in Ground floor near Blood Bank.

CUG Number: 8754081075/ 8754081094

Email Id:insurance@naruvihospitals.com